Despite the growing demand for research that engages stakeholders, there is limited evidence in the literature to demonstrate its value -or return on investment. This gap indicates a general lack of evaluation of engagement activities. To adequately inform engagement activities, we need to further investigate the dividends of engaged research, and how to evaluate these effects. This paper synthesizes the literature on hypothesized impacts of engagement, shares what has been evaluated and identifies steps needed to reduce the gap between engagement's promises and the underlying evidence supporting its practice. This assessment provides explicit guidance for better alignment of engagement's promised benefits with evaluation efforts and identifies specific areas for development of evaluative measures and better reporting processes. Keywords: comparative effectiveness research • evaluation • patient engagement • patient-centered outcomes research • PCOR • review • stakeholder engagement BackgroundEngagement of patients and other healthcare stakeholders (herein, stakeholder partners) is increasingly recognized as essential to patient-centered comparative effectiveness research (CER), which is intended to answer questions of importance to patients and their caregivers [1]. Often described as researchers doing research with patients, rather than for, at or to them [2][3][4], patient-engaged research implies a level of involvement that extends beyond the role of research subject [5]. This shift has been fueled in part by the 2010 creation of the Patient-Centered Outcomes Research Institute (PCORI) by Congress with the passage of the Patient Protection and Affordable Care Act. PCORI is committed to producing and promoting high-integrity CER that is 'guided by patients, caregivers, and the broader healthcare community.' [6].The PCORI Methodology Report states that patient engagement can include: defining topics and formulating study questions, identifying a study population and choosing interventions, comparators and outcomes, developing optimal strategies for recruitment and retention of study participants, conducting a study and analyzing results and disseminating research findings into clinical practice [7]. Generally, the value of engaging stakeholder partners in research is that it can help reorient and improve the research enterprise, reduce clinical uncertainty and speed adoption of meaningful findings that hold great promise with the ultimate goal of improving patients' care experience, decision-making and health outcomes [6].Despite the growing interest in and demand for research that engages stakeholder partners -or, 'research done differently,' [8] there is limited evidence in the published literature to demonstrate the value -or return on investment -of this engagement. This evidence gap is reflective of a general lack of evaluation of research engagement activities. In fact, the majority of published research with a stakeholder partner engagement dimension does not include an evaluation component [9][10][11]...

Purpose The field of patient-centered outcomes research (PCOR) continues to develop. Patient-reported outcomes, and in particular, the Patient-Reported Outcomes Measurement Information System (PROMIS) contribute complementary data to clinician-derived outcomes traditionally used in health decision-making. However, there has been little work to understand how PROMIS measures may inform or be integrated into PCOR or clinical applications. Methods Lead investigators from four pilot projects funded by the Patient-Centered Outcomes Research Institute (PCORI) collaborated to discuss lessons learned about the use of PROMIS in PCOR studies via virtual and in-person meetings. In addition, a qualitative data collection tool was used to assess the pilot projects’ experiences. Results Lessons learned from the pilot projects centered on practical elements of research design, such as choosing the right outcomes to study, considering the advantages and limitations of the PROMIS short forms and computer adaptive technology versions, planning ahead for a feasible data collection process, maintaining the focus on patients by ensuring that the research is truly patient-centered, and helping patients and providers make the most of PROMIS in care. Conclusions The PCORI Pilot Projects demonstrated that PROMIS can be successfully used to conduct research that will help patients make decisions about their care. Interest in PCOR continues to grow and the lessons learned from these projects about the use of PROMIS will be helpful to investigators. Given the numerous benefits of PROMIS, implementing this tool in research and care will hopefully lead to significant progress in measuring health outcomes that are meaningful and relevant to all stakeholders.

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In 2011 day-case prostate surgery was selected for financial incentives in the UK by the Department of Health Payment by Results (PbR) scheme, with a target of 30% of holmium laser enucleation of the prostate (HoLEP) procedures as day cases for 2011-2012, increasing to 90% within three years. The objective was to determine the feasibility and safety of day-case HoLEP. Patients and methods: All patients presenting to an experienced HoLEP surgeon and requiring prostatic surgery were considered for day-case HoLEP. We developed a four-hour postoperative discharge protocol with specialist urology nurse assessment and discharge. Results: Between April 2011 and March 2014, 188 patients (median age 74, range 48-92) were eligible for HoLEP surgery. Four patients did not undergo surgery, and 70 (38%) did not fit the day-case criteria. The remaining 114 (62%) were considered for day surgery, of which 91 (80%) were successful. There was one readmission with haematuria and blocked catheter, and two late readmissions with secondary bleeding. Conclusions: Day-case HoLEP is feasible and safe, even in patients with significant comorbidity. Our overall day-case rate of 49.5% exceeds the initial 30% target set by PbR, but suggests that the 90% target is overly optimistic. KeywordsBenign prostatic hyperplasia, day-case surgery, holmium laser enucleation of the prostate Date

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